The pharmacist's role in managing patients with Alzheimer's disease.

Early recognition of Alzheimer's disease is important, because medications can slow but not reverse cognitive decline, offering the benefits of delaying the onset of troublesome behavior and loss of independence, easing caregiver burden, and delaying placement in a long-term care facility. Researchers are assessing whether pharmacologic treatment might be useful in patients with mild cognitive impairment. Dietary factors and alterations in lipid levels are increasingly believed to be important factors in Alzheimer's disease that are modifiable through lifestyle changes and medications. [table: see text] The cholinesterase inhibitors are similarly effective for maintaining cognition or delaying decline, however tacrine is no longer widely used because of its hepatotoxicity and donepezil produces fewer gastrointestinal adverse effects than do rivastigmine and galantamine. During counseling and education, pharmacists should understand that patients are interested in maintaining independence, while caregivers (family members) are concerned with patient safety.